The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Tuesday, November 03, 2009

British government hospital kills a baby

Equipment shortage plus untrained staff = a baby dead

A premature baby, Poppy Davies, died after being given a ''massive overdose'' of glucose following a series of blunders at London's Great Ormond Street Hospital. Poppy was transferred to the leading children's hospital in London for specialist care after she was born three months early on Christmas Eve last year, in Basildon, Essex. But she died after a "domino effect" of mistakes, an inquest was told.

Rebecca Tite, a trainee nurse, who had spent just three weeks in the hospital's neonatal intensive care unit, set up a machine supplying her with glucose incorrectly, flooding her body with the solution. The levels of glucose in Poppy's blood rose to 20 times the maximum level they should have been, causing ''devastating effects'' to her body, St Pancras Coroner's Court in central London heard.

The machine that nurses would have preferred to use to give Poppy glucose would have prevented an accidental overdose being given to her, the inquest heard. But the equipment was not available after being taken away to help threat a five-year-old boy suffering from meningitis who had needed it urgently.

Both Mrs Tite and Claire Kirk, the senior nurse on duty on January 11, the day of the overdose, failed to check the safety clamp on the syringe that was then used to provide glucose. As as result, instead of being carefully measured, a free flow of glucose entered Poppy's bloodstream and circulated for over an hour.

The nurses then failed to respond to alarms that sounded in the baby's cubicle which could have alerted them to the fatal error, as they were treating her for breathing problems instead. Doctors eventually tried to save Poppy's life by giving her insulin but she died on February 1.

Coroner Dr Andrew Reid recorded a narrative verdict outlining the circumstances of five-week-old Poppy's death, but said it was a ''tragic accident''. Police investigated the incident but concluded there were no suspicious circumstances.

Speaking after the inquest, Poppy's father David Daly, a fireplace fitter from Greys, Essex, said he hoped the hospital had learned from its mistakes. He said: ''It's heartbreaking, but what can you do. You've just got to carry on fighting.'' Poppy's mother, receptionist Karly Davies, was too upset to comment. She wept throughout the inquest and had to leave the court several times because of her distress.

Dr Reid said the errors contributed to a "domino effect" that ultimately caused the death of the little girl, who weighed just 1.63lb (740g) when she died - less than a bag of sugar. He said: "I have come to the conclusion that this was a tragic accident in the course of her healthcare. "It reflects a number of features recognised in terms of clinical risk management where there are a number of steps that have not been taken to prevent the outcome occurring. "A domino effect applies, and the failure of one preventative system leads to another, with the result that, sadly, a fatal overdose of dextrose was given from which Poppy could not recover.

"It is not possible to say on a balance of probability when, after the overdose started, the point of no return was reached. "This is a very rare occurrence and there is no literature to say what could or should have been done, other than in a child big enough and fit enough, dialysis may be an option." It is not possible to know if Poppy would have survived had the overdose not been given.

Mrs Tite, who was undertaking a year-long training course in intensive care, said she had over six years' experience of looking after "very sick children", however. She has now left Great Ormond Street Hospital, telling the inquest: "I found this incident devastating and distressing and was no longer able to continue my placement there."

The hospital has now changed the way it provides glucose to babies to prevent such a tragedy happening again. No post-mortem examination was carried out on Poppy, but the inquest heard that she died of multiple organ failure following the glucose overdose.

A spokesman for Great Ormond Street Hospital said: “We have apologised to Poppy’s family, conscious of the enormous loss they have suffered. At every stage of the investigation we have sought to keep them informed as the most important people who have to know. “Our internal investigation has shown that this incident occurred due to human error. No further disciplinary action has been taken. “Competent, caring and qualified staff made a mistake.” Policies and procedures have now been amended in the light of Poppy’s death, he added.

Sen. Joseph I. Lieberman (I-Conn.) said Sunday that no health-care reform bill at all is better than legislation that includes some form of a government-run public option. "The truth is that nothing is better than that (a public option) because I think we ought to follow, if I may, the doctors' oath here in Congress as we deal with health care reform: Do no harm," Lieberman said.

Lieberman, a critical vote for Senate Democrats in the health-care debate, said a public option, unlike extending insurance coverage to the uninsured and controlling premium costs, was never a priority until recently. The former Democratic vice-presidential candidate, now an Independent who caucuses with the Democrats, said he would not filibuster to stop debate on health reform, but he feels strongly about discarding any public option. He called public option backers who have declared their stance as the only way to true reform as part of a "classic Washington" scenario that is stifling debate while broad bipartisan support exists for a host of other important reforms.

He pointed to a report from Congressional Budget Office, released on Friday, that figured "a less healthy pool of enrollees" would probably be attracted to the government-run option, resulting in higher premiums than the average private plan.

TWO THINGS supporters of a government-run "public option" for health insurance know for sure. One is that private health insurers are raking in obscenely high profits. The other is that only a government rival can force them to compete on price.

In a clever new commercial featuring Heather Graham as an agile sprinter named "Public Option," the left-wing pressure group MoveOn combines both themes, describing insurance companies as "lazy" and "bloated from the profits of raising our health care costs sky-high." Why, it asks, should anyone resist the competition a public option would generate? After all, "competition is as American as apple pie." In a less amusing print ad a few weeks ago, MoveOn charged that "insurance companies are willing to let the bodies pile up, as long as their profits are safe."

President Obama also attacks health insurers as avaricious profiteers: "The insurance industry is making this last-ditch effort to stop reform," he declared on Oct. 16, "even as costs continue to rise and our health-care dollars continue to be poured into their profits (and) bonuses." When he addressed Congress in September, Obama insisted that only a public option will "keep insurance companies honest." On the White House Blog, ObamaCare opponents are accused of "fighting to protect insurance industry profits."

Indeed, there is no shortage of voices characterizing health insurers as greedy villains. Earlier this year, House Speaker Nancy Pelosi praised her party for highlighting "the immoral profits being made by the insurance industry." On CNN last week, Ohio Senator Sherrod Brown demanded a public option "so the insurance industry can't continue to game the system and discriminate" against women and the disabled -- tactics insurers have used to "quadruple their profits in the last five years." If quadrupled profits don't seem rapacious enough, the union-backed Health Care for American Now! ups the ante, claiming, according to the AFL-CIO's news blog, that "during the past five years, health insurance company profits have soared by 1,000 percent."

Outbidding them all is Senate Majority Leader Harry Reid. Health insurance companies "are so anti-competitive," he said last month, "because they make more money than any other business in America today."

To such overheated agitprop, the only useful response is a cold shower of facts, and the Associated Press supplied a timely one last week. For all the impassioned talk about obscene profits and bodies piling up, AP's Calvin Woodward reported, "health insurance profit margins typically run about 6 percent" of revenues, a return "that's anemic compared with other forms of insurance and a broad array of industries."

87 cents out of every premium dollar pays for medical services, according to a PriceWaterhouseCoopers study for America's Health Insurance Plans. Insurance company profits account for just 3 cents.

On the Fortune 500 list of top industries, health insurance companies ranked 35th in profitability in 2008; their overall profit margin was a mere 2.2 percent. They lagged far behind such industries as pharmaceuticals (which showed a profit margin of 19.3 percent), railroads (12.6 percent), and mining (11.5 percent). Among health insurers, the best performer last year was HealthSpring, which had a profit of 5.4 percent. "That's a less profitable margin," AP noted, "that was achieved by the makers of Tupperware, Clorox bleach, and Molson and Coors beers."

For the most recent quarter of 2009, health-insurance plans earned profits of only 3.3 percent, ranking them 86th on the expanded Yahoo! Finance list of US industries. The application-software industry, by contrast, is pulling in profits of nearly 22 percent. Why aren't MoveOn and the Democrats demanding a "public option" to compete with Microsoft and Adobe and drive down their "immoral" profits?

There are certainly industries doing worse than health insurance -- airlines and newspapers, for example -- but the notion that health insurers "make more money than any other business in America today" is preposterous. Advocates of a public option may find it tactically expedient to paint insurers as insatiable predators, swollen with ill-gotten profits. The reality is otherwise.

Still, the critics do have one thing right: More competition would bring down health-care premiums. But the way to increase competition is not by adding a government-run health plan to the 1,300 private firms already providing Americans with health insurance. After all, there's no public option for auto insurance and life insurance, yet they're sold in a highly competitive national market. There is no reason health insurance can't be sold the same way.

Former Labor Secretary Robert Reich writing in the American Prospect, Oct. 26

While health reform, if done right, can help American families stay afloat in the economy, most Americans will not see any appreciable decline in the cost of health insurance nor clear improvement in the efficiency or quality of the health care they receive, and those who will benefit from the bill won't see it for several years. That's partly a result of Obama's sharpest break from Clinton—whose ambitious plan drew immediate fire from Big Pharma, the American Medical Association, and health insurers: The Obama White House bought off the medical-industrial complex by promising it fatter profits, bolstered by tens of millions of new paying customers.

That and other deals cut with industry—including promises to Big Pharma that Medicare wouldn't use its bargaining clout to reduce drug prices, to the AMA that doctors wouldn't have to face larger cuts in Medicare reimbursement rates, and to private insurers that the White House wouldn't fight hard for a public insurance option—will make the resulting reforms far more costly. These extra costs will be borne by those Americans who will be required to buy insurance but won't qualify for federal assistance, along with Medicare beneficiaries who will be paying more and receiving less. These people may not know they're indirectly paying the costs of buying off these industries, but they'll know they're getting shafted (Republicans will be sure to make them aware, even though the GOP has a much longer record of shafting the middle class for the benefit of big business).

It's possible that Obama can pivot off a health-care victory and launch some new initiatives that palpably and quickly spur job growth. The worry is that there aren't any—at least none that can work fast enough to reverse the tide of unemployment before the midterm elections. Fiddles such as a new jobs tax credit can help, but they won't make much of a dent. Even with a larger stimulus, a jobs recovery would still be far off. The tangible benefits of health-care reform are likely to be so elusive in the meantime that the public may become easy prey for demagogues on the right who blame Democrats for the insecurities that bedevil the nation next November.

If Obama and the Democrats lose Congress in the midterm elections, which is not a small possibility, it will be because the president learned only the most superficial lesson of the Clinton years. Health-care reform is critically important. But when one out of six Americans is unemployed or underemployed, getting the nation back to work is more so.

Speaker of the House Nancy Pelosi (D-Calif.) unveiled on Thursday the Democratic Leadership’s plan for expanding government control over health care. The bill would create a government-run insurance plan, expand Medicaid, institute new taxes on insurers, medical products manufacturers, businesses, and individuals, and create subsidies for moderate-income Americans to buy insurance.

Competitive Enterprise Institute Senior Fellow Gregory Conko issued the following statement today condemning the new draft of the House Democrats’ health reform bill:

The House Democrats’ health care bill is a recipe for exploding costs, and it poses a genuine threat to patient care and long-term medical innovation. The bill eliminates a substantial amount of consumer choice by dictating the benefits and prices for insurance policies, and it imposes billions of dollars worth of new taxes on the private sector. Worse still, the only mechanisms that could reduce the annual rate of health care cost inflation would erect government barriers between patients and their doctors.

The Affordable Health Care for America Act is anything but affordable. It will force millions of Americans to pay higher health insurance premiums, it taxes individuals who would like to purchase insurance options that don’t meet standards set by Washington bureaucrats, and it forces businesses and individuals to pay for insurance benefits they don’t want and don’t need.

House Democrats have also given us a bill that would create new programs designed to keep patients from receiving costly, but necessary, treatments. The revised bill stipulates that studies on the comparative effectiveness of various medical treatment options should not be considered as “mandates for payment, coverage, or treatment.” But, nothing in the bill would prevent other programs intended to eliminate wasteful medical spending from implementing these “recommendations” into physician and hospital payment practices.

Eliminating genuine waste and inefficiency from government programs is a laudable goal, but Democrats have been open about their desire to use comparative effectiveness review as a tool to control the practice of medicine. And that puts patient health at risk. Doctors know that what works for the average patient doesn’t always work for everyone. When it comes to medical treatments, doctors and patients need choices because one size definitely does not fit all.

Of all the problems facing the United States right now, none are more important than health care. President Obama says rising costs are driving huge federal budget deficits that imperil our future, and that there is enough waste and fraud in the system to pay for health care reform if it was eliminated.

At the center of both issues is Medicare, the government insurance program that provides health care to 46 million elderly and disabled Americans. But it also provides a rich and steady income stream for criminals who are constantly finding new ways to steal a sizable chunk of the half trillion dollars that are paid out each year in Medicare benefits. In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

This story may raise your blood pressure, along with some troubling questions about our government's ability to manage a medical bureaucracy.

If you want to find Medicare fraud, the first place you should look is South Florida, where 60 Minutes and correspondent Steve Kroft were told it has pushed aside cocaine as the major criminal enterprise. It's a quiet crime - there are no sirens or gunfire. The only victims are the American taxpayers, and they don't even know they are being ripped off.

FBI Special Agent Brian Waterman, who 60 Minutes rode with for several days, told us the only visible evidence of the crimes are the thousands of tiny clinics and pharmacies that dot the low-rent strip malls. You don't even know they're there because there's never anyone inside. No doctors, no nurses and no patients. "This office number should be manned and answered 24 hours a day," Waterman explained, standing outside one of those small, unstaffed businesses.

The tiny medical supply company billed Medicare almost $2 million in July and a half million dollars while 60 Minutes was there in August, but we never found anybody inside, and our phone calls were never returned.

Sometimes, they don't even have offices: we went looking for a pharmacy at 7511 NW. 73rd Street that billed Medicare $300,000 in charges. It turned out to be in the middle of a public warehouse storage area. "They've already told us that there's no offices here," Waterman told Kroft. "There are no businesses here. In fact they are not even allowed to have a business here."

Waterman is the senior agent in the Miami office in charge of Medicare fraud. And Kirk Ogrosky, a top Justice Department prosecutor, oversees half a dozen Medicare fraud strike forces that have been set up across the country.

The office Kroft visited operates out of a warehouse at a secret location in South Florida and includes investigators from the FBI, Health and Human Services, and the IRS. "There's a healthcare fraud industry where people do nothing but recruit patients, get patient lists, find doctors, look on the Internet, find different scams. There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare," Waterman explained.

"They've figured out that rather than stealing $100,000 or $200,000, they can steal $100 million. We have seen cases in the last six, eight months that involve a couple of guys that if they weren't stealing from Medicare might be stealing your car," Ogrosky explained.

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here